2005 OPEN FORUM Abstracts
APTAÉR HELIOX DELIVERY DEVICE; CLINICAL USE OF A NOVEL HELIOX ADMINISTRATION SYSTEM
Jodette A. Brewer, RCP, RRT, Ruta B. Steinell, RCP, RRT, Sharp Memorial Hospital, San Diego, CA., Donna S. Murphy, RCP, RRT, Sharp Grossmont Hospital, La Mesa, CA.
Introduction: Heliox is useful in respiratory distress due to its low density, resulting in reduction of turbulent airflow and reducing airway resistance, therefore, lowering the patients' work of breathing (WOB). Pressure Support (PS) assists patients' spontaneous breathing effort by delivery of a set pressure when a patient takes a breath. The combination of the heliox and PS provides a more efficient therapy along with standard medication to overcome exacerbations of respiratory insufficiency disease states. Heliox and PS, along with a bronchodilator and other standard medications, are already commonly used for spontaneously breathing patients with acute respiratory insufficiency. At our institutions this therapy is currently delivered via an ICU ventilator (for both invasive and non-invasive), or heliox alone can be administered via a non-rebreather mask. The AptaérT Heliox Delivery System from GE Healthcare is a FDA-cleared commercial device designed specifically to deliver heliox with a sealed face mask using PS. Other selectable values and features include trigger, rise, end flow, and a built-in Aeroneb® Pro nebulizer.
Case Summaries: We initiated the Aptaér device on five patients ranging from 31 y.o. to 55 y.o., 4 female, 1 male. All patients were diagnosed with asthma and/or COPD exacerbation. In this retrospective chart review, each case was analyzed to determine if this new FDA cleared device can be more efficient and effective than the standard heliox delivery systems. Patient "A" was extubated from a ventilator with in-line heliox and placed on the Aptaér. We felt this patient was able to be extubated early and refrained from re-intubation secondary to the added PS benefit with heliox. Patient "B" was placed on the Aptaér in the ER and was discharged rather than being admitted. Patient "C" was placed on the Aptaér also in the ER and was later admitted to IMCU rather than the ICU. Patient "D" was in the ICU when placed on the Aptaér and intubation was prevented. Patient "E" was also in the ICU and previously on BiPAP. We felt adding heliox would be advantageous secondary to the patient's primary diagnosis, therefore switched to the Aptaér. The patient's status continued to deteriorate and (s)he was subsequently intubated.
Results: Data reflects before (b) placement on the Aptaér and during (d) Aptaér heliox delivery. Work of breathing (WOB) was from the RCP physical assessment notes.
Patient: RR: b/d HR: b/d SpO2%: b/d FIO2%: b/d WOB: b/d
A 25/20 92/90 95/96 25/30 ↑ / ↓
B 26/28 95/88 99/100 21/40 ↑ / ↓
C 28/28 124/120 92/100 21/40 ↑ / ↓
D 30/21 119/108 91/100 21/30 ↑ / ↓
E 24/21 113/105 96/97 60/30 ↑ / ↑
Discussion: What differentiates Aptaér from typical heliox administration systems are the ease of use, therapist's time spent setting-up and initiating heliox therapy, as well as delivering a bronchodilator without the need of a secondary gas source. Heliox tank storage in close proximity of anticipated Aptaér usage is necessary. If this is not possible, then there most likely will be a delay in treatment.
Conclusion: Our knowledge gained to assist our decision making in which form of non-invasive heliox delivery has been most beneficial. We recommend this new device as an early intervention therapy approach on respiratory insufficient patients. Analysis of potential cost saving is recommended.